This research study is a Phase II clinical trial. Phase II clinical trials test the safety
and effectiveness of an investigational drug to learn whether the drug works in treating a
specific disease. "Investigational" means that the drug is being studied.
The FDA (the U.S. Food and Drug Administration) has not approved pembrolizumab for this
specific disease but it has been approved for other uses.
The study drug is an antibody that targets a molecule called PD-1. PD-1 is used to turn down
the immune system. In general, this is used by the body to prevent the immune system from
being too active. However, several cancers appear to use this pathway to prevent the immune
system from attacking them. The theory behind this study is that by blocking PD-1, we may be
able to prevent the cancer from hiding from the immune system and allow the immune system to
attack the cancer more effectively. There is evidence that the type of lymphoma the
participant have may use PD-1 to escape the immune system.
Inclusion Criteria:
- Be willing and able to provide written informed consent for the trial.
- Histologically confirmed diagnosis of a histiocyte/dendritic cell neoplasm or
relapsed/refractory aggressive lymphoma with at least one of the following features
(with review required at a participating study center):
- Diffuse large B cell lymphoma with EBV positive tumor cells (defined as positive
EBV-encoded RNA in tumor cells)
- Plasmablastic lymphoma
- T cell/histiocyte rich DLBCL
- EBV+ T cell lymphoma of any histology; note, patients with angioimmunoblastic T
cell lymphoma will be eligible regardless of EBV status
- Histiocytic sarcoma
- Follicular dendritic cell sarcoma
- Interdigitating dendritic cell sarcoma
- For patients with histiocytic sarcoma, interdigitating dendritic cell sarcoma, or
follicular dendritic cell sarcoma only: disease that is not amenable to surgical
resection and/or radiation therapy with curative intent.
- For lymphoma patients only: At least one prior systemic chemotherapy including an
alkylating agent and anthracycline (unless contraindicated), and an anti-CD20
monoclonal antibody if the tumor is CD20+.
- For lymphoma patients only: Participants must have received and relapsed after
autologous stem cell transplantation (ASCT), or be ineligible for ASCT (including on
the basis of refractory disease), or have declined ASCT
- Age 18 years or older at the time of signing consent.
- ECOG performance status of 0 or 1 (Karnofsky ≥70%, see Appendix A)
- Participants must have normal organ and marrow function as defined below:
- absolute neutrophil count ≥ 1,000/mcL
- platelets ≥75,000/mcL (> 30,000 if there is bone marrow involvement with
lymphoma)
- total bilirubin < 1.5 times the institutional upper limit of normal (ULN) OR
direct bilirubin < the normal in subjects with total bilirubin >1.5 times the ULN
- AST(SGOT)/ALT(SGPT) ≤2.5 × institutional ULN or < 5 times ULN in patients with
known hepatic involvement with lymphoma
- albumin > 2.5 mg/dl
- creatinine < 1.5 times the normal upper institutional limit OR creatinine
clearance ≥60 mL/min/1.73 m2 in participants with creatinine levels > 1.5 times
the normal upper institutional limit
- INR, aPTT or PT < 1.5 times the ULN unless subject is receiving anticoagulation
therapy as long as PT or aPTT are within therapeutic range of intended use of
anticoagulant
- Be willing to provide tissue from a newly obtained core needle or excisional biopsy.
Newly-obtained is defined as a specimen obtained up to and including 90 days prior to
treatment day 1. Subjects for whom newly obtained samples cannot be provided may be
enrolled only with agreement by the overall PI.
- No prior allogeneic transplant unless all of the following apply:
- At least 5 years from time of transplant
- Absence of clinically significant graft-versus-host disease (GVHD)
- Not on immune suppression
- Approval of overall PI
- Not a candidate for potentially curative therapy at the time of enrollment
- Measurable disease per the Lugano criteria.
- Female subjects of childbearing potential should have a negative urine or serum
pregnancy test within 72 hours prior to receiving the first dose of study medication.
If the urine test is positive or cannot be confirmed as negative, a serum pregnancy
test will be required.
- Female subjects of childbearing potential must be willing to use an adequate method of
contraception as outlined in Section 5.4.3 - Contraception for the course of the study
through 120 days after the last dose of study medication.
- Abstinence is acceptable if this is the usual lifestyle and preferred contraception
for the subject.
- Male subjects of childbearing potential must agree to use an adequate method of
contraception as outlined in Section 5.4.3- Contraception, starting with the first
dose of study therapy through 120 days after the last dose of study therapy.
- Abstinence is acceptable if this is the usual lifestyle and preferred contraception
for the subject
- The effects of pembrolizumab on the developing human fetus are unknown. Should a woman
become pregnant or suspect she is pregnant while she or her partner is participating
in this study, she should inform her treating physician immediately.
Exclusion Criteria:
- Prior treatment with a PD-1, PD-L1 or PD-L2 inhibitor
- Has had a prior anti-cancer monoclonal antibody within 4 weeks prior to study day 1 or
has not recovered (i.e., < grade 1 or at baseline) from adverse events due to a
previously administered agent.
- Participants who have had chemotherapy, targeted small molecule therapy, or
radiotherapy within 2 weeks prior to study day 1 (6 weeks for nitrosoureas or
mitomycin C) or who has not recovered (i.e., < grade 1 or at baseline) from adverse
events due to previously administered agents. Note: subjects with < grade 2 peripheral
neuropathy are an exception to this criterion and may qualify for the study.
- Radiation therapy within 2 weeks of study treatment
- Is currently participating and receiving study therapy or has participated in a study
of an investigational agent and received study therapy or used an investigational
device within 4 weeks of the first dose of treatment.
- Has a known history of active tuberculosis
- Has known psychiatric or substance abuse disorders that would interfere with
cooperation with the requirements of the trial.
- Has an active infection requiring systemic therapy.
- Has active autoimmune disease that has required systemic treatment in the past 2 years
(i.e., with the use of disease modifying agents, corticosteroids, or immunosuppressive
drugs). Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid
replacement therapy for adrenal her pituitary insufficiency, etc.) is not considered a
form of systemic treatment.
- Has a diagnosis of immunodeficiency or is receiving any form of immunosuppressive
therapy within 7 days prior to the first dose of trial treatment or is taking chronic
systemic steroids (in doses exceeding 10 mg daily of prednisone equivalent) within 7
days prior to the first dose of trial treatment. Note: Subjects with asthma or chronic
obstructive pulmonary disease that require intermittent use of bronchodilators,
inhaled steroids, or local steroid injections are not excluded from the study.
- Has a history of non-infectious pneumonitis that required systemic corticosteroid
treatment or has active pneumonitis.
- Known active central nervous system involvement and/or carcinomatous meningitis.
Subjects with previously treated brain metastases may participate provided they are
stable (without evidence of progression by imaging for at least 4 weeks prior to the
first dose of trial treatment and any neurologic symptoms have returned to baseline),
have no evidence of new or enlarging brain metastases, and are not using steroids for
at least 7 days prior to trial treatment. This exception does not include
carcinomatous meningitis which is excluded regardless of clinical stability.
- Known additional malignancy that is progressing or requires active treatment.
Exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of the
skin that has undergone potentially curative therapy or in situ cervical cancer
- Active hepatitis B (e.g., hepatitis B surface antigen reactive) or hepatitis C (e.g.,
hepatitis C virus RNA detectable).
- Human immunodeficiency virus (HIV 1/2).
- Is pregnant or breast-feeding, or expecting to conceive or father children within the
projected duration of the trial, starting with the screening visit until 120 days
after the last dose of trial treatment.
- Has received a live vaccine within 30 days of planned start of study therapy. (Note:
seasonal influenza vaccines for injection are allowed as they are inactivated;
however, intranasal influenza vaccines are live attenuated vaccines and are NOT
allowed)
- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to pembrolizumab.
- Baseline pulse oximetry <94% or requires oxygen supplementation of any kind
- If subject underwent major surgery they must have recovered adequately from the
toxicity and/or complications from the procedure prior to starting therapy.
- Uncontrolled intercurrent illness including, but not limited to symptomatic congestive
heart failure, unstable angina pectoris, or cardiac arrhythmia
